Razi Journal of Medical Sciences

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Acute and isolated inflammation of the uvula is one of the rare manifestations of COVID-19 virus. In this article, we have introduced two definite cases of this disease without significant pulmonary manifestations. Causes of acute and isolated swelling of the uvula include bacterial infections, viral infections, angioedema, direct mechanical trauma to the uvula - some systemic and inhaled drugs, and idiopathic causes. In this study, two patients, who referred to our otolaryngology department with acute swelling and isolated uvula with a diagnosis of COVID-19, along with lack of sufficient knowledge about the course of the disease and how to respond to treatment in these patients due to lack of similar cases in the articles, are introduced. The first patient was a 41-year-old man who complained of a foreign body sensation in his throat, dyspnea, and progressive sore throat. The patient reports a history of low-grade fever and occasional fatigue and dry cough from about 9 days ago, which partially improved. In the two days before the visit, the patient had progressively nausea following the sensation of a foreign body in the throat. The patient neither reported a history of smoking or drug use, nor a previous history of underlying disease. On initial examination, the inside of the uvula was swollen and erythematous. Baseline oxygen oxygenation was 91% at baseline, reaching 96% after receiving oxygen through the nasal cannula. Respiratory rate was 26 beats per minute and heart rate was 112 beats/minute. The patientchr('39')s body temperature was recorded at 38 degrees. Due to the swelling of the uvula and the feeling of suffocation, the patient was prescribed 8 mg of intravenous dexamethasone. For rule out accompanying epiglottitis and other accompaniments, lateral neck and chest radiographs were taken from the patient without epiglottitis. Other diagnostic tests were requested according to the air space opacity in the lower left lung area and the history of viral infection symptoms. The patient was admitted to the intensive care unit for accurate monitoring of respiratory and vital signs. Within hours of receiving intravenous dexamethasone, uvula swelling was significantly reduced. Following definitive diagnosis of COVID-19 based on paraclinical tests performed for the patient, hydroxychloroquine, naproxen, coamoxyclav and atorvastatin were started with continued intravenous dexamethasone and the patient was discharged the day after admission due to improvement of symptoms and relative relief of swelling. The patient was transferred to the ward and discharged two days later with a quarantine order and continued medical treatment at home, and two weeks after discharge the patientchr('39')s symptoms completely disappeared. The second patient was a 28-year-old man who had referred to the otolaryngology department a few hours earlier without any symptoms, including fever and pulmonary symptoms, with a mild headache two days ago, a sore throat, and a foreign body. The patient did not report any history of allergies, underlying disease, or smoking. As in the first patient, severe swelling of the uvula with erythema was observed during the initial examination. The patientchr('39')s basal oxygen level was 94%. The patient had a respiratory rate of 20 beats per minute and a heart rate of 90 beats per minute. With the initiation of supportive measures and receiving 8 mg of intravenous dexamethasone and rejection of the presence of concomitant epiglottitis and improvement of the patientchr('39')s general condition, CT scan of the chest was performed with axial parenchyma.
Scattered Ground-glass turbidity was observed on CT scan and other diagnostic tests were requested according to the CT scan view and clinical findings. After one day of hospitalization and improvement of uvula swelling and due to the appropriate level of oxygen secretion, the patient was discharged from the hospital with a quarantine order and with prescriptions of hydroxychloroquine, naproxen, cetirizine, co-amoxyclav, and atorvastatin. Like the first patient, the patientchr('39')s symptoms completely improved after two weeks of follow-up. The basis of treatment of acute isolated uvula edema is the symptomatic treatment. Treatment options for isolated Iola edema include acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and antibiotics that cover common organisms, as well as corticosteroids and antihistamines. In addition to receiving the COVID-19 treatment protocol, our patients underwent routine treatments for uvulitis patients, and their recovery was similar to that of other patients with acute edema and isolated uvula with causes other than COVID-19 in the studies. According to our findings, COVID-19 can be taken into consideration in the differential diagnosis of acute systemic diseases with viral causes.

Keywords: Acute Isolated Uvulitis, COVID-19, Dexamethasone

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